I don't know much about politics. But I do know that I am very sad that the former Prime Minister of Pakistan, Benazir Bhutto, has been assassinated. I'm glad I live in a country where opposition party leaders do not get killed.

http://www.cnn.com/2007/WORLD/asiapcf/12/27/bhutto.obit/index.html

by the way, I'm sure this does not bode well for our boys in Iraq and Afghanistan.

Tuesday, December 25, 2007

1. She had a 65% chance of living 6 months with the transplant. Does that make the transplant mandatory? What if there was another possible recipient with a greater chance of living longer and healthier? 2 out of 3 people live 6 months- I would not take those odds for me, I would for my kids.

2. Everyone is saying the insurance company should pay for every transplant. I think that these should be made on a case by case basis, with some basic criteria as a baseline. Those transplants ain't cheap, and the after care is not easy on the recipient. Remember, a bone marrow transplant from her brother caused the liver failure.

3. CIGNA did not kill the girl, leukemia and liver failure did. Cigna had nothing to do with the leukemia and liver failure.

4. One newspaper editorial said that if a doctor says a procedure is OK, then it should be covered by the insurance company. I appreciate the vote of confidence, but you don't want me to have absolute power to order treatments for you. There is too much new information with new treatments with new benefits and new side effect to just let me run amok. Most doctors, like most people in general, will chose the treatment that pays the doctor best. The pendulum has swung too far in the insurance companies' favor, but physicians still need that check to our authority.

5. The payment for the transplant was refused on December 11th. The family could have given an OK, then sought media attention to pay for it (it probably costs more than a million dollars, so it's not easy to pay for). To say the insurance company stopped the transplant is false- CIGNA decided not to pay for it. When your insurance refuses to pay for your MRI, you can still get one, you just have to pay for it.

6. What was the girl's condition at the time the transplant was denied? Was she in a coma at that time? Why isn't that part of the media story?

7. It's so sad when a kid dies. I hope the family an come to terms with the fact that she died amidst all of the legal battles.

I am the last person in America who likes the bowls. All of them. I like the fact that Florida Atlantic, BYU, and New Mexico all finished their seasons with a post-season win. But this post is specifically about one of those games.

The Pioneer Las Vegas Bowl pitted a disappointing UCLA team that had just fired their coach ad was using their 4th string QB against BYU- who happened to be on a 9 game winning streak. Both teams played with the sort of intensity you see when my 2 year old wants THAT COOKIE. Guys were making diving catches, big time tackles, and occasional brain farts. BYU's captain got hurt in the first half, came back in, and got hurt again. He waved to the crowd to say thank you for their cheering in a classy move. Several UCLA players also played valiantly with injuries. It was a hard fought, well played drama. UCLA had a chance to win if they could kick a field goal at the end. They drove from their 2 yard line to the BYU 10. On the last play- UCLA's kicker- who had made 2 50 yard field goals, lined up for a 30 yard chip shot.

And it was blocked!

The BYU players that got to the kick put up the ind of Herculean effort you see in an action movie. The BYU players ran out on the field, jumping and hugging. UCLA's captain cried like he lost a national championship. For a meaningless bowl- it sure was great theater and meaningful.

The article above is about a private practice that is trying to improve business practices without compromising patient care. What I find interesting is the idea that PCP's should see 30-35 patients a day. It's do-able, but not preferable. Patients want more time from their doctors. Doctors need to see more patients as reimbursement per patient is decreasing. The current practice models are not sustainable in the long-term unless all of us join large groups.

Meanwhile, concierge practices see 10-15 people per day and make more money- without having to deal with insurance hassles. More money per patient and fewer patients calling after hours. It sounds great for me, but I can't say the same thing for the general public (especially the general public in the lower 75% income group). As someone with a struggling new practice, I have to choose between the bird in the hand (low reimbursement insurance covered patients- of whom there are many) and the bird in the bush (a concierge practice- where I have to hope that there are at least 250 families willing to give me $2,500 per family to care for them). I definitely need to phrase it as $200 per month.

But with practices going out of business and large group practices being slow to move into some of the new suburbs, the general public is beginning to lose access to health care services due to a lack of PCP's. This is a problem for both the poor and the middle class. I don't have a solution that is workable, I'm just saying this is an unrecognized problem.

Thursday, December 20, 2007

Great game. Just unreal. It felt like a conference tournament game. It went back and forth and into overtime. The game was at Madison Square Garden in NY- meaning you had a smart, basketball savvy crowd. You had Duke alum Jay Bilas calling the game- even admitting some of the charge fouls against Pitt were "close". That's code for "crap". Duke got out to a big lead, Pitt fought its way back in it, and prevaied in OT. A few thoughts:

1. Last year, Duke coach Mike Krzyzewski did not seem focused. The team was not prepared for games, missed free throws, and seemed to run around randomly instead of usig set plays late in close games. Since last summer's FIBA tournament, where Coach K coached NBA stars, he seems refreshed and has his fire back. And his team ran plays that worked. Of course, at the end of OT with no timeouts, his team ran around like headless chickens, but the other 45 minutes they looked prepared to win. Next time, coach, prepare your team for the possibility that they may be down 2 with 4 seconds left and no timeouts. It's happened before.

2. Duke just hustles.

3. So does Pitt.

4. Before I die, I want to see a basketball game Madison Square Garden.

5. Both of these teams can beat the Knicks.

6. Pitt coach Jamie Dixon had his team well prepared, made good adjustments in the second half, and kept his team focused after a player suffered a serious injury. He is good at all of the aspects of college coaching (recruiting, season planning, game planning, in game adjustments, play calling, keeping the team focused, and dealing with adversity). I know he has not had much success in the NCAA tournament, but it's just a matter of time.

7. Last year, Duke's point guard Greg Paulus was an overrated crybaby. Now, he's a good floor leader and a solid player who may get to cut down a net at the end of the big dance.

8. College refs reward flopping, especially by Duke.

9. Pitt rhymes with "legit". Seems appropriate.

10. You know it was a good game when my 5 year old did not want to go to bed- and immediately fell asleep once the buzzer sounded

In case you haven't noticed, the NBA has gotten a lot better over the last few years. Yesterday had 4 good close games- Houston/Orlando (Yao vs. Dwight Howard), San Antonio/Memphis (Rudy Gay's coming out party- no pun intended), Dallas/Phoenix (the 2 most recent MVP's going at it for conference supremacy in the West), and Boston/Detroit (Mr. Big Shot- and former Celtic- Chauncey Billups comes up big AGAIN in Boston over the BIG 3). I mean, did you catch any of that? You better.

First, the local game. Yao and T-Mac have done so much for the community. they do all kinds of fund raisers, open up new businesses, and travel the world to help the poor and down-trodden (T-Mac went into Darfur to help bring attention to the genocide there. But these 2 admirable men have not led Houston to a playoff series victory. So the locals are disgruntled. Last night we got a visit from the Magic. Orlando's big man- 20 year old Dwight Howard, is proof that evolution is still occuring in a positive manner. Their new $126 million forward Rashard Lewis (a former local HS player who skipped college) was also on display. The Magic won, the Rockets and their fans keep grumbling.

Wednesday, December 19, 2007

If you're reading this, you officially qualify as easily entertained. Or just bored. So, to make it worth your time, here's some advice:

Get life insurance.

Seriously. I try real hard with the doctoring thing, but if you're my patient, you're going to die. Ditto with every other doctor. If you use a chiropractor, naturopath, accupuncturist, hypnotist, or Psychic friend, you're still mortal. Assuming that you have any family, and they depend on you for financial support, you will want to make sure to provide for them in case you pass away early. I know it can't happen to you, but since it happens to other people, pretend it can happen to you.

My wife and I just pulled off our 3rd Annual Christmas Party- in our kids' names of course. It was epic in scale and grandeur. A good comparison would be the party that accompanied the Fall of the Berlin Wall. Except we had Santa Claus instead of David Hasselhoff. If you don't have kids, you don't want the oh so cute details. If you do have kids, you don't want the gory details. Let's just say that 28 kids from 11 months to 11 years old attended , and sugar cookies were heavily involved. At one point we had 2 craft stations going while kids played stik the nose on the clown (you don't want pin the tail on the donkey with 2 and 3 year olds- real pins, real pin holes).

I can still hear the noise. It's echoing in the family room. It's sitting in the kitchen. And lingering in the playroom.

Thursday, December 13, 2007

State Rep. Harold Dutton represents 3rd Ward, a historically Black neighborhood that contains Texas Southern University. TSU has had a LOT of financial trouble through the years. So has Mr. Dutton:

http://www.chron.com/disp/story.mpl/ap/tx/5371263.html

Now that's entertainment.

Meanwhile the Mitchell steroid report has been issued. Thank goodness! I'm glad the whole steroid era is over and we can get on with our lives. I think the real winners in this episode are:1. The children, who all athletes and politicians seem to represent2. the Lawyers, who represent the politicians and the athletes and collect fees.

Wednesday, December 12, 2007

A local man shot and killed 2 people who broke into his neighbor's home. He called 911 and told the operator he was going to shoot the robbers. A plain clothes policeman was in the area, but he did not identify himself and witnessed the shooting.

Now everyone in Houston is upset about this incident. Some folks are mad that the neighbor may face murder charges, others are mad because he may not face murder charges. I just have a few thoughts/questions:

1. If you can shoot people who break into neighbor's homes, how far away is someone's house to call them a neighbor?2. Would people get upset if the neighbor missed and hit an innocent bystander?3. Why do local minority activists rally around criminals shot by white people, but not criminals/innocent people shot by minorities?

I'm in favor of a full investigation by a state or federal internal affairs office (the municipality n question has a poor history regarding police work in general). If the neighbor broke the law, he should have his day in court. In general, we shouldn't shoot people unless our lives are in jeopardy. The risk of hitting an innocent bystander increase when untrained persons are shooting at moving targets when they are nervous or in an excited state.

Sunday, October 28, 2007

I live in the Greater Houston area, which means I have to watch the Texans. It's pretty easy to miss how the Texans have fallen from 2-1, with the one loss being a close one against the Colts, to 3-5, with the win coming on a 57 yard field goal against the (embarrasing) winless Dolphins. A lot of people blame the running backs, the line, and the stunning number of turnovers (11 in 2 weeks).

I blame a lack of depth on the offensive and defensive lines. The O-line is made of various cast-offs and low round draft picks. The D-line is made of first round draft picks- the cream of the crop.

They are the foundation of any football team.

The Texans offense was hummng and going initially- until Steve McKinney (center) got hurt. The running game fell apart, which meant that defenses could key on the passing game, which meant that people had trouble getting open, which meant that they don't keep the ball, which means the defense is ALWAYS on the field. Which leads to tired defensive lineman that can't tackle or sack anyone because they are getting more and more tired as the season wears on (and it is wearing on).

Now the local papers talk about the new fangled running backs playing poorly and all world receiver Andre Johnson getting hurt. And the turnovers. But the root cuase is the lack of depth in the offensive and defensive lines.

Thursday, September 27, 2007

I am a huge Dallas Cowboy fan. And the 3-0 start has me full of confidence and smugness that only Cowboys fans (and Yankees and Laker fans) can have.

But I'm rooting for the Oklahoma State Cowboys!!!!! First, they get horse-whippped by Troy. Then they give up 700 yards of offense to Texas Tech, win by 4, and the coach doesn't even bring it up during the press conference. Instead, he belittles and berates a female columnist for saying that his newly demoted, heavily recruited second string quarterback is a mama's boy with a glass jaw. And the Texas Tech defensive coordinator gets fired. That, my friends is excitement!

Although Coach Gundy (who I've followed since he was the OSU quarterback in the 80's) was wrong to publicly berate the columnist, and wrong for not saying what was inaccurate about her story, and wrong for ignoring his own team's exciting victory; he was dead on about defending his player. While Texas Tech coach Mike leach fired his Defensive Coordinator (effectively saying,"It ain't my fault"), Coach Gundy put his stones on the table for a back-up quarterback who has been very disappointing at best. I bet his players play hard for him. They know that when all else fails, coach will embarrass himself and sacrifice himself for their benefit. If you don't think an 18-23 year old doesn't appreciate that kind of loyalty, go to a gang riddled neighborhood and see what those kids do for each other in the name of loyalty.

Coach Gundy was wrong to go off like that, but anybody who will go to bat for a second team player has some good in them.

Friday, August 31, 2007

10 years ago, we lost Princess Di and Mother Teresa. The editorial labove talks about how our reactions 10 years later show our skewed priorities. I'd like to point out that at least Diana went to Africa to rally support for poor people and amputees from left over land mines. She could've just hung out in the castle and partied. So she is being memorialized by those who love her- her children and celebrities (her peers). At least she made a postitve contribution to life that had nothing to do with fashion.

And I'd like to point out that Mother Teresa is being memorialized by her friends- the poor. The poor just don't get as much air time and media play.

Friday, August 24, 2007

As a true NBA fan, I have been watching the FIBA America tournament. I've missed wathcing the game, and with all of the Tim Donaghy stuff, it's just nice to just enjoy the game.

Now, the international game is different. In the NBA, Michael Redd is not more important than Tim Duncan. But with the widened lane and shorter 3 point range, it's a different ball game. Other nations do not have a slew of coordinated men 6'7" or more, so the international game emphasizes spacing, good pick and rolls, and moving the ball around by passing. This greatly contrasts with the NBA's 1 on 1, dribble game.

So this year, we got different players to fit the international game. Kidd, Kobe, Redd, and 'Melo are getting it done. I put this link up here to show how many NBA fans forget this is a different game. It doesn't matter if Stoudemire and Howard score from the low post. It does matter that 'Melo and LeBron are scoring in the paint- to open up long range jumpers for Redd, Chauncey Billups, Deron Williams, and Mike Miller.

Thursday, August 23, 2007

Some interesting facts:1. The Rangers left 19 men on base.2. Wes Littleton came into the game to protect a 16-3 lead. He got his first save of the year for his effort.3. The Rangers managed to strike out 11 times.4. In the 2nd game of the doubleheader, the Rangers scored 9 runs, which ain't so bad. Somehow the Orioles stranded 23 runners.5. The orioles announced they are keeping their current manager for next year.

Friday, August 3, 2007

Wasn't defamed NBA referee Tim Donaghy supposed to charged with some form of an indictment, or he was supposed to plead guilty to something? Well, I remember he was supposed to be arrested or turn himself in to authorities. None of these things has happened. And somehow this is getting no press. After a couple of weeks of breathless announcements and denouncements, suddenly nothing is happening.

Every tragedy always gets the same story from sports writers.http://sports.espn.go.com/espn/news/story?id=2958962&lpos=spotlight&lid=tab5pos2I'm not making light of a lot of people dying due to engineering problems. I'm not saying this does not "put things into perspective". I'm just saying I'm tired of the same story being written. I mean, give me "Random guy jumps in river and saves 2-10 people". I already know watching games ain't that important- that's why I watch.

That being said, I'm glad the death toll isn't higher. It could've been worse.

Wednesday, August 1, 2007

You can do whatever you want to with healthcare funding, but this is the biggest problem out there. Disjointed care makes it real hard to take care of a mobile population. And with the general lack of consensus on treatment guidelines, and the regional variability of quality facilities and staff....

http://www.chron.com/disp/story.mpl/headline/metro/5008923.htmlI like how researchers always say,"Just give us more money for (insert diagnosis here) research and we'll get you a cure. SOON!!" Plus- heart disease kills more people than cancer. I'm cool with cancer research, but I don't think it will lead to a cure in the next 10 years if the state of Texas invests $1,000,000 a day for 10 years. Science does not work this way. It's trial and error and trial again.

Saturday, July 28, 2007

I can't write about this case rationally. I can't believe anyone would prosecute a case like this unless they had very clear evidence a physician or other hospital employee was murdering patients. After 4 days, if the staff had any ability to think at all, it's a miracle. Instead of being heroes, the hospital staff (but not the administrators?!?!?!) are paraded around like criminals. Shameful.

Thursday, July 26, 2007

"Where have you gone Joe DiMaggio? Your place has been taken by thugs and crooks and cheats."

Richard Justice of the Houston Chronicle is lamenting the sad state of our athletes and one official. It sure make for an eye-catching headline. And there is no better way to make fans feel better than pointing out the many foibles of millionaires.

But, um, isn't there more to the story than these people are bad and evil and must be stopped? I think I can figure that out by myself. If I am reading a column I want more than "Dog fighting is wrong and should not be tolerated." How about at least some info about the ASPCA or some detail about the mental and emotional state of a person who engages in dogfighting.

Now, in Mr. Justice's defense, yesterday he had a glowing column about how great Craig Biggio has been for the last 20 years, and how Biggio is the true embodiment of a great player, family man, and role model.

But Mr. Justice is ignoring many facts. Back in the good ole days, Babe Ruth was a womanizing drunk, Joe DiMaggio was a wife beater, and NBA referees and college basketball players were involved in gambling scandals (in fact, NFL Hall of Famer Paul Hornung missed a year of pro football due to a gambling suspension). The 1980's gave us a wide variety of recruiting scandals with "under the table" money in college football, while basketball and baseball had a cocaine problem. Bad news is not new. Overblown coverage with preachy columnists is new.

By the way, Houston Texans running back Ahman Green paid for someone's down payment on a home last week, in exchange for a jersey number. Teammate Jason Simmons and team owner Bob McNair were involved as well. In other news, the afore mentioned Craig Biggio spends a lot of time raising money for kids with cancer (see this link http://www.sunshinekids.org/who-we-are/spokesperson.htm to help Craig help kids!!)

Sunday, July 22, 2007

No, not Mr. Posh Spice, although I watched a game involving an MLS team for the first time, while texting a friend the entire time. He's part of the reason.

But soccer has a chance because the other 3 major leagues are all having serious problems. Baseball's owners and commisioners can't explain why they let steroids go unchecked, thus compromising the integrity of the game. Fortunately, Barry Bonds is making sure that even the good headlines bring bad news.

Speaking of Bad Newz- the NFL players are are embarrasing the league, (boat cruise strippers, Vegas strippers, illegal weapons, drunk driving, Whizzinators, Dog fighting with executions, and the Bengals). It's easy to "get tough" with Pacman Jones, Tank Johnson, and Chris Henry. But now that it's the highest paid player in the sport, getting tough is getting tough to do. Can someone tell me why this is bigger news than wife beating and killing people while drunk? (because this is the first time it made the news, I know. I'm just anti wife beating and anti drunk driving. My public service announcement is over. Thank you)

And the NBA now has a gambling saga with a twist- a referee has been implicated. After last year's NBA Finals when Dwyane Wade shot more free throws than the Mavericks, I assumed the refs were under duress to make the series close. But to have outside people (like the mob) influencing the officials? And everyone's reaction was, "I bet it's (insert referee's name here)."

Heck, even wrestling is having a major crisis (complete with an all-to-real tragedy).

The last time a major sport lost a major chunk of fan base due to its own stupidity was in 1994 with the baseball players' strike. A lot of fans (including me) boycotted baseball. And just at that moment, Andre Agassi and Pete Sampras began to dominate tennis and captivate the media. Meanwhile, Tony Hawk and Dave Mirra started getting famous for their X-Games X-ploits. It took baseball 3-4 years (and a lot of roided up players) to catch up. Meanwhile, I still watch tennis occasionally.

Please note hockey has made 2 of those mistakes. A coach and Wayne Gretzky's wife have been implicated in a gambling ring. And the sport took a year off to discuss union issues, thus losing pretty much every American fan. Here's my advice to the NHL- INCREASE SCORING and fighting.

So for the first time, soccer has a legitimate chance to become mainstream. It's main competition is busy damaging itself as we speak. All they have to do is play well, which Beckham's LA Galaxy squad did not do against the Chelsea side. Cuahetemoc Blanco is coming from Mexico. We have Canada's best player in Houston (DeRosario). They have until Labor Day weekend (FOOTBALL- American football) to keep my attention. Will MLS become the next NASCAR or XFL?

Friday, July 20, 2007

A particular health insurance company has been the bane of my existence. They lost my paperwork when I enrolled. Their physician payment rates are lower than anyone else's, unlike their stock price or bonuses to their executives. They have been hosing patients, too- increasing payments and having inconvenient "glitches" causing them to lose money in their HSA accounts.

Then when they said I could get paid to see their patients, they entered the wrong address, phone number and Tax ID number, so they could not send any payment for 3 months. Then, they denied payment on some claims because we did not submit them properly (with address and Tax ID number matching their database) within 90 days. According to our calculations, this company owes my office at least $10,000.

But here's the kicker: this week, they actually mailed me a bill.

Yep, they claimed to have overpaid my office for one claim, so they want a refund. Insurance company "X" has gone from underpayment, to denying payments, to charging payments when doctors see their patients.

On a related note, the same company was going to fine doctor's offices $50 every time one of their patients was sent to a non-contracted lab.

Thursday, July 19, 2007

Did you hear that Michael Vick was indicted in a dog fighting ring? How about (insert lurid detail here)!???!?!?!

The op/ed and sports columnists are having a field day riding their high horses all over the place with this one. It's an emotionally charged story with a little bit of race relations thrown in. Good sales all around.

If I'm paying for good journalism, I want to know the following:1. How do people get involved in dog fighting?2. What is the appeal in this "sport"?3. Where is the righteous indignation about cock fighting? And why is the University of South Carolina not being asked to change its "Gamecocks" mascot?4. Why did the Falcons let their 2nd string QB go to the Texans for a 2nd round draft pick when Federal charges were being considered for the first string QB?

Instead, I get a bunch of stories and columns about gruesome details and pontification about how bad this is and Vick should be punished. Duh....

By the way, I don't think coverage of this story smacks of racism. When everyone was doing the same bad journalism when the Chris Benoit story broke, no one said this was because he was white and Canadian. Ditto with Ken Lay, Jason Giambi, Congress, the Iraq war, corporate backdating......

Addendum- Rev. Al Sharpton is now involved. Does he just sit around the bat cave by the bat phone waiting for injustice to occur so he can call a press conference? Can't dogs get a better advocate than the always available Rev. Al?

You know how the stock market keeps hitting new highs, while the spending power of most of us is getting lower? Here's some perspective why. This is also why I read more than one newspaper- to get more from a story besides a number and quotes from useless talking heads.

The best thing about the last week in June is that the COLLEGE FOOTBALL preview magazines come out. I can not remotely talk about the upcoming season because by the time I've read the 3rd magazine I am convinced that Rice will make a bowl game.

Oh wait, that happened last year.

This years Athlon guide did just that in two good articles. One is about the details that go into play calling for an offensive coordinator and staff.

The other, a review of the top 40 recruits in 2002. Out of those 40, only 2 were first round draft picks (Haloti Ngata and some guy who couldn't make the Texans "team"- VINCE YOUNG!!!!!!!). More than half of the players did not get drafted at all. Injuries, better players and legal problems catch up to a lot of people, including gifted athletes. Just a good look back at the experts predictions.

Friday, June 29, 2007

I love the NBA Draft. I just wish that the TNT crew did the draft show so Charles Barkley would be involved. In fact, the announcers should be Barkley, Kenny Smith, Stephen A. Smith, Dick Vitale, and Ernie Johnson. I'd TiVo the draft to hear those guys talk, but I'd keep the volume down.

I love the Oden/Durant debate. It's like Jordan vs. Olajuwon- you're going to win with either of those guys.

I love that Rice's Morris Almond was picked ahead of anyone from Duke.

I love the random foreigners who scored 9 points a game in a European "B" league. Especially when they get guaranteed money.

I love when head cases like Sean Williams get picked when they couldn't stay on their college teams. Especially when they get guaranteed money. Maybe Eddie Griffin will help coach Williams.

The one thing I would like to see the draft people do is a 5/10/15 year retrospective. It would be nice to hear what the experts were right and wrong about at different stages. That way, we can find out if the experts are really experts.

Monday, June 25, 2007

Alli- the new FDA approved weight loss medication, is a low dose version of prescription Orlistat.

Have you noticed how many FDA approved prescriptions have gone over the counter?

Prilosec, Zantac, Pepcid, Claritin, Mucinex, Alli- just to name a few.

I think it's good that if a medication proves to be safe and effective, consumers can get them without a prescription and without having their insurance pay. It saves the system money while still helping the patient get the care they need. The only real drawback is that people think that the Over-the-counter medications are somehow now "less strong". Alli is less strong that Orlistat because it has fewer milligrams per dose.

Friday, June 22, 2007

Another NY Times article about ranking hospitals. I would like to believe that there is a way to objectively rank hospitals and doctors. I want to know if I'm doing a good job and how I can improve. However, I also want to avoid being sued if I'm not THE best doctor. I'm sure most hospitals feel the same way.

But the public (rightfully) want to know which hospitals are better than others. But we don't know how to find that out, or even what questions to ask to find out. In general, hospitals in poorer areas have worse mortality scores. Is it because the patients are sicker when they arrive at the hospital, or because they receive poor care. I can think of a number of cases I have inherited where a patient who I'd never seen before is assigned to me, and they are on death's doorstep. If I continue to take these patients, my "scores" will decrease, just like for the hospital that takes these patients.

3 points I'd like to make

1. Most hospitals are average, and half are below average. The real litmus test should be "acceptable". What if the worst hospital was still acceptably good?

2. Doctors and hospitals will cherry pick the least sick patients. And death certificates will become less accurate to help "massage the data".

3. As mentioned at the end of the article, people will go to the better hospitals, leaving less resources for the "inferior" ones. So people will lose valuable time in cases of stroke, sepsis and heart attacks, while some hospitals will become more profitable.

4. Hospital systems will close their campuses in poorer areas. If poorer areas always have worse scores, and worse scores means less funding, and less funding means closing all of the hospitals.....

Thursday, June 21, 2007

Wednesday, June 20, 2007

Baytown, TX is a community east of Houston best known for its many refineries and myriad of odors. This week, 2 groups of teenagers from Baytown made the front page of the Houston Chronicle:

6 who stole a car and ended up in a wreck near some dangerous train tracks (4 died)5 who wrote and performed a play about the lynching of Emmitt Till in the 1950's (and won a national award)

Of course, the kids who stole the car got front page headlines 3 days and articles on the first page of the City/State section, while the budding thespians got one front page and a page 2 City/State mention. The worst part is:

I read more of the kids in the stolen car stories than the playwrights. Dang it!

It's hard to be righteously indignant about not promoting good kids when I pretty much fall right in line without being prompted. I should blame others, but, um, well, it's my parents' fault!

When you ask why the news shows more tragedies and crime stories at the expense of feel good stories, check your own habits (but not mine).

Tuesday, June 19, 2007

Adam Dunn is one of my favorite baseball players. I like guys who either hit home runs or strike out. That pretty much sums up Dunn, a 21st century Rob Deer. But if you're a major league general manage, you're not trying to keep me entertained, you're trying to get to the playoffs. So columnists weigh in on the issue, mostly commenting on his strikeouts or home runs. But which stat is more important?

There are new, trendy stats like VORP (value over replacement player). According to Baseball Prospectus, Dunn is 44th out of 753 ranked players. To compare, likely All Star Carlos Lee (El Caballo!!!!) is ranked 71st. (http://www.baseballprospectus.com/statistics/sortable/index.php?cid=204127)

That being said, he hits a LOT worse away from the Great American Ballpark (home of the Cincinnati Reds). If you're trading for him, you better be the Pirates GM. I think he'll do worse post trade, especially if he goes to the American League. (http://sports.yahoo.com/mlb/players/6763/splits;_ylt=Av6i_I4nZx3xj5Vm4bPEugqFCLcF)

Maybe he is better than Rob Deer. If I needed someone to get me in the playoffs, I'd get him (he produces more runs than the average player). But in the playoffs, his high strikeout rate would be a liability (remember, pitchers on playoff teams tend to be better than pitchers on inferior teams). I wouldn't take him (I wouldn't want a high strikeout player in my lineup).

In 2003, Hip-Hop dominated the Billboard charts. In 2006, High School Musical ruled. What in the Sam Hill happened?

Well, I noticed that guys like Chingy and Akon were making new music instead of people with talent. Meanwhile, the people with talent were busy selling clothes with names like RocaWear, Ecko, and Apple Bottom.

In other words, the best (and business savvy) stars like Jay-Z, Eminem, and Nelly have figured out that they can make more money not making music. So the best music talent is getting paid to do non-musical things. If Elvis would have gotten a cut off of those ceramic plates, he wouldn't have had to keep touring as an overweight 40 something.

So while Hip-Hop music is suffering, Hip-Hop culture is spreading. But if the quality of music keeps dropping (not like it's hot), will the culture continue to spread?

Saturday, June 16, 2007

I don't know what it's like to have cancer. I don't want to know. I do know when I talk to people with cancer, I try to treat them like they are alive and normal. Because they actually are alive and normal. Even when it's obvious they only have a few hours to live, if they're conscious, I'm cracking jokes and talking about my kids or sports (note, that's all I do in general).

Anyway, I'm babbling. Just pass this along to someone you know who has cancer.

Friday, June 15, 2007

The San Antonio Spurs just won their 4th NBA championship in 9 years. If someone were reading this, they would stop now, because no one likes or respects the Spurs. I lived in San Antonio for 4 years and couldn't become a fan. But at least I came to respect the team work, chemistry, good coaching, unselfishness, and championship rings. In an era where people complain about athletes with poor fundamentals getting arrested and having outside kids, the Spurs stand out by:

1. Winning, early and often2. Playing team ball3. Not getting arrested4. Starting schools for underprivileged children5. Marrying hot actresses

So what's not to like? People just like complaining.

But then I realized something. The Spurs are Larry Holmes. Larry Holmes won his first 47 (or so) heavyweight fights and was one fight away from tying Rocky Marciano's record when he lost his first fight. He held the Heavyweight title for 6-8 years. And no one cared because he followed the greatest era in boxing history (Ali, Frazier, Norton, Foreman- with guys like Lyle, Shaver, and Leroy Spinks playing second fiddle) while preceding the Mike Tyson era.

The Spurs missed the Bird/Magic era and the Jordan era. They even had the bad luck of missing Shaq and D. Wade in the Finals last year. LeBron, Wade, Chris Bosh, and Carmelo are coming into their own, while Kevin Durant and Greg Oden loom on the horizon. So they're playing in a lackluster era and they are the best team of that era. But we don't know how Holmes or the Spurs would stack up against the best from more competitive eras because they did not have great competition, so we denigrate their achievements.

Or, they are so much better than their contemporaries that they just make them look bad. Nah, Cleveland was bad. So was Carl "The Truth" Williams.

Note- Oh, and the middleweights and welterweights got to be very entertaining during Holmes' reign. Sugar Ray, Hagler, Hearns, Duran. They had some great fighters with compelling personalities.

1. OK, how do you pay for quality? And is every complication a sign of poor quality?

2. Patients who are high risk will be denied treatment. Why treat someone when you will lose money?

3. What if the hospitals that had better scores for bypass surgery did bypass surgery on people who should have had the less expensive and less risky angioplasty? Overall, their costs would have been higher as far as less effective care.

Monday, June 11, 2007

In the 1970's, the US gave financial backing to he Shah of Iran in order to keep a stabilizing ally in the Middle East. The result, the Shah was deposed and an anti-Western, Muslim government took over. With plenty of US made weapons and cash.

In the 1980's, the US supported Iraq in an effort to destabilize Iran's anti-Western Muslim government. Iraq, led by Saddam Hussein, won a brutal war over its neighbor. Then with its US made weapons they invaded Kuwait. Oops. Our occupation of Kuwait led to having US troops in Saudi Arabia, which led to various groups like al Qaida getting more recruits to fight against us.

We also supported various Afghan warlords in the 1980's against the USSR. That led to the Taliban ruling in Afghanistan. Another anti-Western, Muslim government.

So when the US is deciding to help Sunni factions to help stabilize Iraq, I have my doubts.http://www.nytimes.com/2007/06/11/world/middleeast/11iraq.html?_r=1&th&emc=th&oref=sloginI think that we will be funding and training the next generation of anti-Western Muslim governments in the Middle East.

Sunday, June 10, 2007

My internship in Family Medicine consisted of varying rotations in other departments. I witnessed this story during my second month of Obstetrics.

A 34 year old woman was admitted to the Labor and Delivery ward. She had 5 healthy children from her 5 previous pregnancies. She had minimal prenatal care. At 8 1/2 months into her pregnancy, she had an ultrasound. It was abnormal. More specifically, the baby was severely malformed- with brain and heart abnormalities that meant the baby would only be able to breathe for a few hours before dying. And the baby's face was hideously deformed. The mother told her family and elected to have the baby naturally to avoid the risk of a Caesarian section. Then she would get her tubes tied because she didn't want to risk having another genetically defective baby.

So this lady with the hideously deformed baby with no real life expectancy showed up with 15-20 family members. Sisters, parents, cousins, and a friend accompanied the woman and her husband. We treated her like any other patient- you still have to prevent infections and care for the mother. She pushed like any other patient. And she delivered a specimen I was not any other patient.

The ultrasound showed that there would be a pear shaped head with protuberant eyes. But it's different when the grainy images are flesh and blood. The top of the head was as wide as my hand down to the cheekbones. The eyes were too big for the sockets and hung loosely by the visible optic nerve in the back. The eyelids were absent, so these eyes kept staring emptily around the room. The bulbous lower face was twice as wide as the upper face. When you touched the cheeks, the top of the head expanded like a water balloon. This did not look human. I think there were more physical issues, but we wrapped to baby in a blanket to keep the baby warm. I remember the genitalia were not developed enough for us to tell if it was a girl or boy.

The family held this blob of temporary flesh, passing it around and admiring it like the Crown Jewels. They coo'd, kissed the baby, and sang lullabyes. They hugged each other and comforted each other in turn. As the baby was breathing its last breath only 45 minutes after its first, everyone began to silently cry, holding hands and praying for this poor soul. When the baby died, it's maternal grandmother, who had thanked God for her new grandchild, told us why all of these people came to see a deformed baby's birth and death.

"We knew the baby was only going to be with us for a few minutes, and we wanted it to know it was still loved while we had the chance."

I didn't watch the Rice vs. Texas A & M game today. The best of 3 series to determine which team would advance to the College World Series in Omaha began Friday night. I didn't watch today because......

RICE SWEPT A&M!!!!

Sure, the Owls got at least one gift call from the umpires. But those umpires will not be in Omaha for the next Rice game.

Do you remember, "If a tree falls in the woods, and no one hears it, did it fall?"

Well, along a similar line of thought, I wanted to write a post about the fact that the NAACP is closing their 6 regional offices and laying off people at their Baltimore headquarters. I heard the report on the Texas Southern University radio station (www.ktsu.com). It seemed like a big deal.

So I did a search of the NAACP website and the local newspaper, the Houston Chronicle. Neither website had a relevant link to the layoffs (Google had plenty of stories, mostly internet stories, although the NY Times had an article). Apparently, the NAACP is having trouble raising funds, so like any responsible enterprise, it is scaling back its operations.

I just assumed that the NAACP would always be relevant enough to be front page news. The organization was the standard bearer for all civil rights organizations from the 1920's through the Civil Rights movement of the 1960's. However, the group was a victim of its own success, losing focus and lacking a cohesive set of goals. It's easy to get people to rally around Jim Crow laws; it's much harder to open good dialogue about affirmative action and the role of Hip Hop in society.

So a venerable oak is being pruned of a few branches. And we won't notice.

Here's a link by the way, http://news.yahoo.com/s/ap/20070607/ap_on_re_us/naacp_cuts

Wednesday, June 6, 2007

A neat article about San Antonio's 3 (soon to be 4) time NBA championship coach. It's interesting to note that top-notch college coaches usually have a rough time making the adjustment to the pro game. While coaches who do an apprenticeship with a pro team have more success. Just remember this when you are trying to evaluate future job prospects.

For my money- I'd like to see more studies present results with "Number Needed to Treat" and "Number Needed to Harm" data. For instance, "This study shows if you treat 50 patients with drug x- you will prevent one death and two heart attacks. You need to treat 1500 people to get liver function problems that are reversible. You need to treat 20,000 people to kill someone with drug x." Instead, I get a lot of statistical static and an editorial that emphatically states I need to prescribe more drug x.

Tuesday, June 5, 2007

How can the US of A improve its anemic health care scores? We rank 5th among the 5 industrial nations (Canada, Great Britain, New Zealand, Germany and USA) that share data about life span, infant mortality, and cost of care. And we don't need to blame Congress, Big Pharma, Insurance companies, doctors, hospitals, or Ralph Nader.

Get a physical.

Less than half of the people with insurance get the recommended screening tests and vaccines for their age and gender. Simple things like fair skinned people getting their spouse to look at their skin once a month can save thousands of lives. Ladies, get your mammograms and Pap smears. Guys, bend over once a year- look at what ladies go through in the previous sentence. And everyone needs to get checked for colon cancer, high blood pressure, cholesterol and diabetes. Even if you believe in Alternative Medicine- go to your Alternative Medicine Practitioner once a year.

I notice that a lot of newspaper columnists criticize a given politician, athlete, coach, general manager, actor/actress, or director with the greatest of ease. In turn, bloggers criticize the columnists or agree with them. I guess the podcasters then follow up with more criticism.

Why?

Because it is easier to criticize than come up with your own thoughts and ideas. Also, if you have a blog, radio/TV show, column, etc., you have to fill space with something. And you can either be original, come up with a top 10 list, or criticize (plagiarize) someone else's work. It's a major part of journalism now. Heck, that's what I've been doing. Shame on me.

The anti-vaccine crowd is at it again. Although it is a known fact that there are side effects to vaccines (some of them serious or even fatal), vaccines were the leading health breakthrough of the 20th Century. I'm OK if you say antibiotics are the leading breakthrough. Either way, my generation did not have to deal with polio hospitals. Between my parents and in-laws (4 people total), 3 of them lost at least one sibling to an infectious disease that is now vaccine preventable. Simply put, the risk of taking vaccines is much lower than the risk of living in a vaccine free world.

Which makes me ask the following:1. Since people die from peanut allergies, why aren't these people trying to get peanuts banned?2. Do they really think drug companies ("Big Pharma") are really out to kill people with shoddy products? I mean, doesn't that lead to fewer people to purchase drugs?3. A lot of people worry about "drugs" but not "natural" or "alternative" medications. Why don't they think that "natural" medications can have side effects?4. Aren't bacterial and viruses natural?5. Why don't "alternative" practitioners willing to do their own double blind/placebo controlled trials? (My guess is if they do a "scientific" study, they will be doing what they oppose, namely putting science over intuition and tradition)6. Have you ever seen a pill, capsule, or gelcap in the wilds of nature? Me neither.

This article is about Medicaid and doctors' payments. Since Medicaid has lost my application 3 times, I'm not currently accepting Medicaid patients (I won't get any money for seeing them until they complete my paperwork). They pay 25-50% less than other insurers. They require more paperwork for referrals and therefore cost me more time (and money) when I see their patients. And they kept me on their provider list after I switched jobs and had to dis-enroll from Medicaid- but medicaid staffers kept signing me up as various patients' PCP. This meant that not only would I not get paid to see the patient, but any other doctor who saw the patient would not get paid either.

At any rate, I'll have to decide whether or not to take any Medicaid patients. As much as I pride myself on accepting patients that other doctors won't, I have to be practical and stay in business, or else I ain't helping anyone.

On a related note, I'll start doing cosmetic procedures this month. I picked procedures that insurance companies do NOT cover. market economics at its best.

Thursday, May 31, 2007

Kevin Garnett doesn't ask for a trade and he gets criticized for staying with a poorly run team with minimal NBA talent and no plan for improvement.

Kobe Bryant does ask for a trade and he gets criticized for wanting to leave a poorly run team with minimal NBA talent and no plan for improvement.

Kobe needs to realize that no matter what he says or does, he will be resoundly criticized and vilified. If he contributes a million dollars to a charity while donating a kidney to an orphan-he's just trying to rebuild his image while decreasing the time he spends pissing. So Kobe, if you're reading this:

Get a life- my family won't read this. Read a book or something. And stick to your trade demands. Michael Jordan couldn't win with Kwame Brown on his team.

Note- Lakers team owner Jerry Buss was arrested for DUI. No one protested or called their local talk show host, despite the fact that 17491 people died in alcohol related accidents in 2006.

29 points in the 4th quarter and 2 overtimes (out of his teams' 30 points)??!?!?!?!?!?!

Wow. A few quick thoughts

1. How bad are the rest of the Cavaliers?2. Could someone wake up the Pistons "coaching" staff? Let them know you can double team the one guy who makes shots before he gets the ball. Let the corpse like players shoot.3. And let them know that you can make him work on defense.4. How in the Sam Hill do you let anyone dunk 3 times late in the game in the playoffs? The bad Boys Pistons would have knocked LeBron back to Cleveland. Knock him down! Maybe after he dunked on thin air twice, switch out of the zone defense. Or get Weber and his bad knee out of the way and put 'Sheed on him.5.Did they tell the Pistons fans not to cheer for most of the game?

So fees to become a US citizen are going up. Pro-Immigration advocates are upset that the fees are increasing dramatically (from $395-$1010). They are not upset that federal authorities are trying to improve service for applicants and reduce wait times for application processing. They are against paying more for better service. Apparently, the fact that it takes money and paid workers to process these forms is not important to them. At least not as important as complaining.

One other note- none of the articles I read about this topic noted when the last fee increase was enacted. If it's been 10 years, a fee increase is needed just to cover inflation.

Tuesday, May 29, 2007

Remember when people thought the Pistons were smart to get Darko Milicic instead of Dwayne Wade, Chris Bosh, or Carmelo Anthony because they won a title in 2004?

Can you imagine how good the Pistons would be if they had Bosh- he'd be the perfect fit. Good post-up game. Can shoot the mid-range jumper. High energy guy. Most people focus on 'Melo and Wade, but Bosh would have been worth one more ring (in 2005- when Detroit lost to the Spurs in 7 games in the NBA Finals) by matching up against Tim Duncan. Meanwhile the Heat "settled" for Wade- who is probably in Charles Barkley's 5.

So please remember that someone who is not Greg Oden or Kevin Durant in this next rookie class will lead his team to a title- possibly before Oden or Durant does.

Question: How many Americans died in alcohol related motor vehicle accidents in 2006?

I'm sure you heard more about Mad Cow Disease, West Nile Virus, the Bird Flu and teen athletes dying of heart disease than drunk driving. All of the above sells more newspapers. But what do you need to worry about more?

The Texas legislature just passed a bill authorizing steroid testing for high school athletes. Now, kids are on the juice, no question. And it's a bad public health problem. It's just that steroids= attention= votes. Drunk driving is so boring; no one wants to vote for the guy who's against drunk driving.

Friday, May 25, 2007

It looks like some medical experts are not too happy with the coverage of the Avandia/cardiovascular risk study. Apparently the limitations of the study stating that Avandia carries an increased risk of cardiovascular events were not noted. Also, the accompanying editorial was written by physicians who make a living saying that medication "x" is dangerous and the FDA needs to do a better job of oversight. Finally, there is concern that the New England Journal of Medicine should not have published the study at all, implying another lesser known journal should have published it. The media coverage is also questioned. This doesn't make for good press in the local newspaper, but it helps me answer patients' questions.

One other point, patients (and the media) tend to believe the doctors who say that medicine "x" is bad for you and can harm you more than doctors who say a product is safe. Meanwhile, doctors are raked through the coals for being pawns of the pharmaceutical companies, while the ones who complain about the FDA and "Big Pharma" make a nice living and a nice name for themselves if they keep finding drugs to condemn. What happens to them if too many drugs are safe?

Houstonian Tom Kirkendall is the son of a physician and a well respected lawyer (yes, it can happen). He is also a sports nut like me. The 2 posts I linked to are about the NBA and my Texas Rangers ("We're Punctual!"). Watch me masterfully link the topics of why the NBA has only had 14 teams win a title and why the Rangers have won one playoff game. And why the NY Times article about a shortage of tall people has nothing to do with who wins championships.

Team titles are won by organizations. The Spurs, Yankees, and Patriots have all had good ownership who realize that team sports are not won by All-Star teams. You have to have a GM who understands team dynamics and salary caps, not just who has the best stats. You need a coaching staff who can integrate young talent with the accompanying lack of experience, veteran talent with the accompanying slower reflexes, and mix it with long term strategies to deal with long regular seasons and short term strategies for playoff series and game planning with adjustments at halftime and good creative play-calling for last second plays. You need scouting departments who can help you pick good talent in the draft, free agent market and in trades while supplying useful information to help win games. You need a good marketing department to keep fans coming to the games and buying apparel and paying everyone's salary.

My Rangers have consistently switched managers and players like they're a fantasy league team. The once great Latin American scouting department has been disbanded for financial reasons (note- this is an unsubstantiated rumor). We paid A-Rod $&) million more than the Mets offered, and we still pay him $10-12 million a year to play for the team I hate from New York.

So LeBron James and Tracy McGrady will be relegated to making cool commercials and never winning a title as long as management keeps letting the Carlos Boozers go to Utah and interviews head coaches before the head coach is fired. The Detroit Lions can draft Jesus himself and sign the Heavenly Hosts to a long term deal and still go 3-13 as long as Matt Millen and the Ford family are in charge. The supply of tall people has nothing to do with the NBA's lack of Championship teams. Rangers' owner Tom Hick's poor management is the reason my team is so bad the announcers complain ON AIR about having to watch this team play the Devil Rays. It's the lack of a Championship level ORGANIZATION.

I am thankful today that I am not as talented as LeBron James. The man can't win for losing. First, he makes a difficult pass to a wide open Donyell Marshall (who looks a lot like Ludacris http://sports.espn.go.com/nba/players/profile?statsId=2627). It turns out it's LeBron's fault that Donyell missed the shot.

The next game LeBron has the nerve to miss the game winning shot. He followed that up by not complaining enough about getting fouled on the play. Larry Hughes, who missed the follow up shot, is not at fault. Everyone complains that Jordan would not have let his team lose

To sum up:1. LeBron should've shot the ball in Game 1.2. He should've passed or made the shot in game 2.3. He should complain like a spoiled baby.4. Jordan is God.

The same media guys complain about guys like Kobe who don't pass, bad officiating, and whiny prima donnas. They also forget that Jordan was a me-first, no title having Nike salesman his first 7 seasons. Can they pass a law making writers research their toic before spewing nonsense about people's character and will to win?

Thursday, May 24, 2007

I had to put a random question when I started this blog. The question was, "What is your favorite cheese?"

Mine used to be mozzarella. Then I was at Target and they had samples of this cheese that was $14.00 a pound. I thought to myself, "Self, one bite is worth a dollar- what a bargain!!" But the cheese was so good, I bought half a pound (for those of you that know me, you KNEW I wasn't buying a whole pound). I forgot the name of it, it's some Italian cheese. But I'm going to write it down and buy some for my next birthday or when my kids get married.

Well, Avandia is the latest medication to have a major advisory after being in the market for a number of years. No one is calling for it to be withdrawn from the market (yet), but patients are being asked to "call your doctor".

Given that I learned about this from the New York Times, I think I only know what the patients know. I have gotten an e-mail from Medscape (a service owned by WebMD, registration required) about Avandia, but I got it one day after the story broke in the print media. I used to take the New England Journal of Medicine, but for major stories like this one, the press release comes out 2 days before the journal gets to my mailbox. Given that most doctors use a computer as often as Paris Hilton says "no", it is rather difficult to get important messages out to physicians.

So go ahead and call your doctor, but please provide us with the reference article, because we probably have not read it yet.

Wednesday, May 23, 2007

I was at the dentist office with my kids and I was thinking, "These are neat people. I like them." Even after my son screamed like a drunken banshee during his exam. And he pooped.

You love them and protect them from day 1. But they just do so much cute, funny stuff (note, the screaming and pooping did not qualify as cute or funny). I like how they want a hug after you tuck them in at night. Adam (age 2) calls a hug "hut". Larissa (age 5) likes to rub noses together.

Tuesday, May 22, 2007

Pharmacy technicians receive an inordinate amount of abuse from patients and doctors. I've seen them get cussed out and blamed for making co-pays too high for the elderly, poor, young, and upper middle class. Most grocery store and big chain pharmacies are unimaginably busy. And no one says thank you to the pharmacy tech. So I usually take their side when patients complain about their pharmacy.

But this is not a rant if I do not complain. I'm tired of calling or faxing a prescription to a pharmacy, only to have the pharmacy technician say that it was not called/faxed. The patient usually calls our office complaining, we call the pharmacy....It just takes up extra time. And the pharmacy tech has to check the phone/fax line anyway. It turns into a sloppy he said/she said that leaves patients having less faith in both aspects of the health care system.

Of course, most of us docs don't get around to taking care of all daily correspondence (faxes, refill requests, referrals, etc.) every day. Can't blame the pharmacy for extra calls when we don't do our jobs.

Two interesting observations. Between pages 3 and 4, I was asked to participate in a reader survey. Likely to get marketing information for a third party. Also, I read an article about culinary school graduates and their mounting debt. The next day, i got 2 e-mails about enrolling in cooking school.

Anyway, if you have elderly family, call them often so they are less likely to fall prey to scam artists who act like their friends.

Thursday, May 17, 2007

I've seen 2 news stories today about food safety. Both focused on the E. Coli 0:157 outbreak in spinach last year. In fact, CNN just ran an ad for a one hour dangerous food investigative report. I wonder if CNN would have been mad if the investigation would have shown that food safety has improved.

Anyway, the point of both reports is that the government and the food industry need to do SOMETHING to make food safer, dang it! Which brings up my question- what do we do?

One report showed that a spinach farm with a good barrier system to keep out bacteria harboring animals can get contaminated if a bird lands in a cow pasture, gets some cow manure on its beak, and poops in the spinach farm that is 10 miles away from the offending cow. Pesticides might be able to reduce the rate of microbial contamination, but then the food does not qualify as "organic". And no one want to pay for irradiated food (and no one knows if that can cause health issues). And according to one expert- the FDA inspects each large food processing plant every 10 years. If they just had more funding and manpower (which means your taxes get raised) they can check every 5 years. Or the government can shift funding from some useless pork like education to pay for this upgrade.

Just once I would like a media outlet to say, we don't have an answer, at this time it is an unsolvable problem.

Monday, May 14, 2007

As the clock struck midnight I was at work on my night job. I admit patients from 6 pm to 6 am for a hospitalist group in Houston. I had just finished the 8th admit. So from midnight to 2 pm I was helping out a resident, entering patient information into the computer for patient care purposes, and entering patient care information for billing purposes.

From 2 am to 6 am I attempted to sleep, Every 20- 30 minutes I get paged, so I can't say I got good rest. I got enough rest to be able to be mildly coherent by 6:15. I saw 2 of the 4 patients I had been assigned from the Emergency Room and left the hospital by 7:30 am. Normally I see all of my admits, but May 12 is.....

My daughter's BIRTHDAY!!!!!! My Larissa is 5. She makes sure to remind us of this fact every 12-15 minutes. And she was having a big party at Bounce U- a place where kids bounce around on inflatable objects while their parents make sure kids stay on the inflatable objects while the parents discuss how we will pay for college when our 5 year olds are 18. Before getting ready, I watch SportsCenter with my son to see who won the Jazz/Warriors game when the see Baron Davis THROW DOWN on Andrei Kirilenko. I think the poster is available in Oakland as we speak. My son voiced his pleasure at seeing such an awesome sight. So then, a quick eat and shower leads to.....

10 o'clock- go pick up the cake from the Cake Lady in Friendswood (note- the best cakes as far as decoration and taste in the Houston Area. I'm getting hungry right now). I take my 2 year old son with me, because my wife is taking the now 5 year old to get her hair and nails done for the bounce party. So Adam Jacob "The Touchdown Maker" (TTM) and I go to pick up the cake, load up on a few groceries, vote in a bond election, get a nice bottle of wine (or 3) for Mother's Day, drop off a Mother's Day card for Granny (my mother-in law, who was working a 742,007 hour shift because she is a florist), and get lunch at McDonald's. All of this while I arrange a hospitalization after getting a call from the lab regarding a patient I saw in the office who had anemia so severe, she needed a transfusion.

Whew.

Back at home my wife and I get TTM and the birthday girl (TBG) down for a nap as we continue to prepare for the party. Of course, TBG is too excited to nap, so she helps clean out the car. I also pass out for an hour or so.

Just before leaving we go across the street to see my neighbor so they can wish TBG a happy birthday. I catch a couple of holes of the TPC Golf Tournament to keep the fan in me happy.

Now it's 4:15 and we arrive at Bounce U with a load of balloons, gift bags for party favors, a cake, and 2 kids. Back when I was a kid, we didn't have all of this pomp and circumstance. We had dirt, rocks, and hard times. Oh, wait- I'm channeling my parents- we had the same crap, I'm just a complainer. Soon, nine 5 year olds arrive with their posses (parents and siblings) and the bounce-a-thon is on. There are no casualties, although TTM may get food poisoning from eating off of everyone's plates (and the floor for good measure).

We leave the party with some leftover pizza, gifts that take a lot more space than the gift bags, and 4 kids. We're keeping my 2 nephews (aged 7 and 2) for my brother-in-law and his wife so they can celebrate their anniversary. So at home my attention is divided between gift opening, the 4 kids, and the Spurs/Suns game. We may have lost a kid or 2, but the game was FANTASTIC. I love playoff basketball. And my family, yes my family. The best part was when Manu Ginobili got hit in the eye, grew a black eye in, like, 15 seconds, and responded by scoring the next 8 points of the game. oh, and the look of joy from my daughter. which may have been sleepiness because she never took a nap while consuming cake and lemonade while playing like a screaming Banshee for 6 hours. Fortunately for the Spurs, the Suns cried about the officiating before the game and got absolutely no love from the refs.

Of course, I missed the end of the game to help give 4 kids a bath and help brush 100 or so teeth and get 3 people to bed. My 2 year old nephew refused to go down easy. So I went back to the hospital to see the patient with the anemia. I met the spouse and we talked for about 15 minutes. It's a little weird to meet someone one day and tell them the need an urgent transfusion the next day. Especially when the person does not have an obvious source.

Finally, I get home, take a shower, and find another male in bed with my wife (my nephew). I respond by getting in bed with them. I spend about 10 minutes in bed when I notice my nephew curled under me, snoring like a freight train, and kicking me like a young Pele. I call this the "baby Hat Trick". In honor of this achievement, I go to the couch so I can sleep.

Roger Clemens is going back to New York. People here in the Houston area are acting like he's taking the petrochemical industry with him. And to think he has the nerve to take the job with more money?!?!?

Oh, wait- I know how to count, too. I'd move for more money (which I did in 2001 at the end of residency). Yes, I took a higher paying doctor job over a lower paying one. Apparently, no one who listens to sports talk radio would do that because they love their employer or hometown too much to take more money for the same job elsewhere.

Friday, May 4, 2007

A man came in today with valid insurance. He had called 3 or 4 other doctors' offices for appointments. Although other offices accepted his insurance, he was told they were not taking new patients with his plan.

When he called our office we "gave" him an appointment. It took us 20 minutes to figure out how to bill his insurance plan (we 'll find out in 90 days). The main reason we gave him an appointment is that he was wheezing really loudly on the phone and he said his blood pressure was high. This seemed urgent.

When he got here we noticed he had trouble breathing, so we started treating him before we got all of the paperwork done. We have a policy here that if someone isn't breathing well, we should do some doctory-like stuff. He was very happy with our service. I simply saw a sick person who had valid insurance.

This has been happening about once or twice a week for the 3 months I have been open. Sick people can't get appointments to see a primary care doctor- even when they have a primary care doctor, on the day they are sick.

Maybe I'll look at this differently when (if) I've been in business long enough to have a full schedule and employees that were not in my wedding as the bride. But isn't it weird that sick people can't find a doctor, even when they can pay the bill?

I was going to write a real entry, but did you see the Warriors/Mavs game last night?!?!?!? Those fans were amazing. I'm not a big fan of the color yellow, but seeing that sea of yellow, yelling, cheering, chanting.....that was cool.

We should have seen this coming. The Warriors made a big trade mid season to get Stephen Jacksona and Al Harrington for the slow Mike Dunleavy, Jr.. Baron Davis has been healthy for the first time since he nearly beat the Magic by himself in 2001. And the Warriors wer 3-0 against Dallas this year.

Anyone seen Dirk's game? Oh, Stephen Jackson took it and is taking it with him to Utah or Houston next week.

(note- GSW usually stands for gun shot wound in medical parlance. Every time I see it on the sports ticker, I kind of jump before I realize it's the Golden State Warriors. Then I remember they play in Oakland and I worry again.)

I have my own ethical dilemma. I'm a primary care doctor. I take care of everything from colds to diabetes. I especially like diabetes, high blood pressure, asthma, and prevention. Every month, guidelines are updated for these and other conditions. New medications, new tests, better health outcomes. There are continuing education classes in great cities to stay up to date. I can even learn online.

And I am getting ready to sign up for a cosmetic procedures class.

If I see a patient for something important, like high cholesterol, I have a 90% chance of getting $40-$120 from their insurance plans. If I perform a Botox treatment or take care of varicose veins, I will get $250-$500 from the patient. Before I sound like a greedy bastard, remember- I'll need to see 8-14 daily (with a staff of me and my wife) to break even doing primary care alone. I would like to stay in business long enough to hire staff and pay them (and Uncle Sam).

Friday, April 27, 2007

I like to read the business section of the newspaper. Coincidentally, I am interested in staying in bsiness with my new practice. One of the columnists that I read reglualy is Loren Steffy of the Houston Chronicle. Today, his column addresses a bank funding a column for another newspaper and how that leads to an obvious conflict of interest.

Of note, he addresses the newspaper industry's financial woes and points out that allowing a business to sponsor a column is a potential revenue stream. As the internet changes how information is disseminated, traditional purveyors of information (newspapers, the evening news shows) are finding it hard to keep people's attention (and revenue). So while Mr. Steffy is right to say that journalistic integrity is compromised by selling a column to a local bank, he fails to address the larger question:

How does a newspaper grow its business while maintaing its independence and integrity?

If a newspaper goes out of business, it probably won't maintain very high standards of journalism.

Wednesday, April 25, 2007

The NBA playoffs are in full swing- which means I will be staying up watching late night West Coast blow-outs just to see if Phoenix can hit 100 points by the end of the 3rd quarter. Kobe and the Lakers were hammered by the Suns by 30 points in the "game". Lakers coach Phil Jackson was powerless to stop the Suns attack.

Jackson has never won a coach of the year award, but has 9 NBA titles. Golden State's Don Nelson has won mltiple coach of the year awards, but no NBA titles. This year, Toronto's Sam Mitchell won the award because the Raptors won 20 more games this year than they did last year. Other good coaches, like San Antonio's Gregg Popovich and Houston's Jeff Van Gundy, made the mistake of having multiple good players on their team. That means that potential voters won't vote for them because they did not have to "coach" as much to get victories. It didn't matter that Van Gundy's best players missed significant chunks of the season. They were dealt a perceived better hand than Mitchell, whose team had an inferior record in an inferior conference.

Meanwhile, Jackson's detractors point to the fact that he has only won titles when he had the most dominant players in the NBA on his team (Michael Jordan, Shaquille O'Neal, and Kobe Bryant). The logic is that anyone can win with the best players. If that is true, why hasn't every season produced a 70+ win team like the Bulls in '95-96? And why have Jordan and Shaq only combined for 1 title without Jackson? (note, Pat Riley, the coach who won with Shaq and Dwyane Wade in Miami, was accused of being overrated because he had the gall to coach Magic and Kareem at the same time) You don't fall ot of bed and win 9 rings no matter who is on your roster. However, he can't get his undermanned Laker team to beat a superior Phoenix team, while Don Nelson has won some playoff serieses (sp?) with small lineups and less than stellar talent.

I think coaching skill is relative. For instance, an authoritarian like Gregg Popovich (owner of 3 rings) would fail miserably with the Bulls of the late 90's because his style would clash with Jordan, Rodman, and Pippen. Phil Jackson can get the most out of veteran players, while a Don Nelson or Avery Johnson can get more from younger players who need more help in skill development.

A better question to ask is: Can Phil Jackson coach a particular team "X"? I ask this given that teams (and businesses and patients) want star coaches and leadres and doctors, when the star does not necessarily have the right skill set for the task at hand.

Monday, April 23, 2007

It is amazing how hard it is to write an intelligible, entertaining post. I've written about 4 that I haven't published because, well, they sucked. I do a pretty good job of speaking- being entertaining yet informative. When I try to write the same thoughts out- the dots don't connect just right. Here's why:

1. I can use voice inflection when I talk. Without proper use of emoticons, you can't replicate that in black and white.

2. I can use my body (facial and hand expressions) while talking. I'm doing it now while writing, but the visual impact is diminished without a webcam.

3. I can get my words out faster talking. I think faster than I type. That leads to missing a few thoughts to get my point across faster.

4. I never shut up as a kid. I got a lot more practice talking than I did writing. That's why was a great listener. Or maybe he was just sleeping.

5. I think in bullett points. That's great for powerpoint or lecturing, but it makes for a lousy narrative. What if Shakespeare and mark Twain just left 5 take home points instead of writing in the vernacular? The Cliff's Notes people would be unemployed.

Friday, April 20, 2007

Kristen Mack of the Houston Chronicle has a good report on the differing opinions regarding fixing TSU's financial problems. One the one hand, TSU has consistently had problems with managing their finances, including the hiring of a CFO with a felony conviction for writing false checks. TSU also has a very low graduation rate (less than 20%). On the other hand, TSU has produced more than it's share of congressmen and women (including Mickey Leland and Barbara Jordan) and a significant number of minority attorneys and pharmacists.

Texas, and its large African American and Hispanic population, needs universities like TSU that accept all applicants. It is part of the foundation of the community and a pipeline for minority talent to find graduate education and skilled jobs (that help the tax base by the way).

It is also a symbol of fiscal mismanagement. If TSU goes out of business (and this happened to Bishop College in Dallas), blaming the state for not sending enough money won't excuse "losing track" of millions of dollars. And cutting academic programs (like the proposed elimination of majors in Spanish and History) make a mockery of the idea of higher education.

Governor Rick Perry wants to have a Consevator manage the university for one year; many others just want to reorganize the Board of Regents. I don't think any of this will matter if the basic culture of TSU does not change. The only way for TSU to become a sustainable, economically viable entitiy is for the students, alumni, faculty, and trustees to decide to hire honest leadership and let them lead without asking them to keep the status quo. there is a tendency to decide to hold on to "traditions" and to keep doing things "the way we've always done them". But since that is consistently leading to outdated facilities and misappropriated funds, radical and unwelcome change will be coming. Hopefully, not the kind of change that causes TSU to close its door completely.

In the last 3 weeks I've lost a grandfather and a close family friend. I'm at the age where most of my friends have had their weddings and/or a child. Now we're at the point where the funerals start. Right now the remaining grandparents (age related illnesses) are going fast, and my parents' generation is going through the round of cancers and early heart attacks.

*Disclosure* As a physician, I've had to attend to the many dying patients. Even when I've been really close to the family, it's a different feeling for 2 reasons. First- caring for the dying is my job, so I've been afforded many opportunities to see this process, while a family only loses Dad or Cousin once. Second, I'm not in the Family/Friends circle- I don't have the memories of the patient being full of fun and life. I remember the patient being full of various fluids that needed to be collected and vital signs. But I digress.

Anyway, now that I am going to more funerals, I have a dilemma- What do I do when I stand in front of the open casket? Is there a protocol? For instance, the first degree relatives get to kiss the body, second degree relatives and close friends may touch the body, all others just linger somberly sounds good. I noticed at my grandfather's funeral, most people got to the casket and just sort of looked confused. There are always the performance artists who do ritual crying/touching/humming dances. I prefer to move away quickly because I don't know what to do and funerals creep me out. I figure the quicker I get out of the way, the quicker the ceremony ends. What should people do?

Last note, at one funeral, my then 7 month old son passed copious amounts of stool that left a fragrant and flagrant trail of tears. So basically, I walked right in and right out of the church, to keep my son's BM from waking up my uncle. I knew exactly what to do then.

I realize that everyone (present company included) is extra sensitive in the wake of the recent tragic shootings. That being said, I strongly disagree with NBC's decision to publish and air video from the shooter.

First, it helps turn the shooter into a type of anti-hero. He viewed himself as a persecuted soul who could do a heroic work by sacrificing himself and others. Unfortunately, there are others like him who feel the same way and can now feel encouraged while watching the video. Second, he wanted to show the world his views by killing people, then having his video aired. If you are a mass murderer and you want to speak from the grave, send your thoughts and images to (fill in the media related blank)......

I just don't think we should honor the shooter's wishes, and NBC did just that.